Save with Keystone HMO Proactive

Save with Keystone HMO Proactive Keystone HMO Proactive plans use a tiered network, so you save on monthly premiums. Plus, you can save even more on your out-of-pocket costs each time you receive covered services. How you’ll save Like a typical HMO, you select a primary care physician who can refer you to specialists. You can visit any doctor or hospital in the Keystone Health Plan East network. We grouped our network into three tiers based on cost and, in many cases, quality measures. While all of the $ $$ $$$ doctors and hospitals in our network must meet high quality standards, many offer services at a lower cost. Tier 1 – Tier 2 – Tier – Preferred Enhanced Standard You’ll pay the lowest out-of-pocket costs when you visit doctors and hospitals in Tier 1 – Preferred. The good news is that more than 50 percent of doctors and hospitals in the Keystone Health Plan East network are in Tier 1 – Preferred. But the choice is always yours, and you can choose Tier 1 – Preferred for some services, and Tiers 2 or 3 for others. We offer two Keystone HMO Also keep in mind the following: Proactive plans • For some services, your out-of-pocket costs are the same no matter what doctor or hospital you use, including For details, visit ibx.com/bluesolutions preventive care, emergency room, and urgent care. • For some services, like surgery, you pay out-of-pocket costs for both the facility and the performing doctor. To save the most money, you’ll want to make sure both are in Tier 1 – Preferred. Blue Distinction Center+ hospitals See the back for a list Blue Distinction Center+ (BDC+) hospitals are recognized for their expertise and efficiency of Keystone HMO in delivering specialty care. With a Keystone HMO Proactive plan, you can save on specialty Proactive hospital care by choosing a BDC+ hospital in Tier 1 – Preferred, while being confident that it: tier placements. • Has extensive experience in one or more categories of specialty care • Meets rigorous quality standards • Consistently demonstrates positive care results Benefits are underwritten or administered by Keystone Health Plan East, a subsidiary of Independence Blue Cross — independent licensees of the Blue Cross and Blue Shield Association. 473094 (9/18) Keystone HMO Proactive hospital tier placements and BDC+ hospitals Tier 1 – Preferred $ Lehigh Roxborough Memorial Hospital St. Luke’s Health Network — Allentown Campus Tower Health — Chestnut Hill Hospital Pennsylvania St. Luke’s Health Network — Bethlehem Campus Wills Eye Hospital Bucks Montgomery New Jersey Aria Health — Bucks County Campus Abington Memorial Hospital Doylestown Hospital Burlington Albert Einstein Medical Center — Grand View Hospital Deborah Heart & Lung Center Montgomery Campus Lower Bucks Hospital Lourdes Medical Center of Burlington County Holy Redeemer Hospital and Medical Center Rothman Orthopaedic Specialty Hospital Lansdale Hospital Camden St. Luke’s Health Network — Quakertown Campus Suburban Community Hospital Cooper Hospital University Medical Center Chester Tower Health — Pottstown Memorial Mercer Chester County Hospital Medical Center Robert Wood Johnson University Hospital Tower Health — Brandywine Hospital Philadelphia at Hamilton Tower Health — Jennersville Regional Hospital St. Francis Medical Center Albert Einstein Medical Center Tower Health — Phoenixville Hospital Albert Einstein Medical Center — Salem Delaware Germantown Campus Memorial Hospital of Salem County Crozer-Chester Medical Center Aria Health — Frankford Campus Warren Springfield Hospital Aria Health — Torresdale Campus Hackettstown Community Hospital Delaware County Memorial Hospital Hahnemann University Hospital Taylor Hospital Jeanes Hospital Tier 2 – Enhanced $$ New Jersey Delaware Pennsylvania Camden New Castle Our Lady of Lourdes Medical Center A.I. DuPont Hospital for Children Philadelphia Children’s Hospital of Philadelphia Gloucester Fox Chase Cancer Center Inspira Medical Center — Woodbury St. Christopher’s Hospital for Children Shriner’s Hospital for Children Tier 3 – Standard $$$ Montgomery Kennedy University Hospitals — Main Line Health — Bryn Mawr Hospital Washington Township Division Pennsylvania Main Line Health — Lankenau Medical Center Virtua Voorhees Hospital Berks Philadelphia Hunterdon St. Joseph Medical Center Hospital of the University of Pennsylvania Hunterdon Medical Center Tower Health — Reading Hospital and Mercy Fitzgerald Hospital Medical Center Mercer Mercy Philadelphia Hospital Capital Health System — Fuld Campus Bucks Methodist Hospital Capital Health System — Hopewell Campus St. Mary Medical Center Nazareth Hospital Penn Presbyterian Medical Center Salem Chester Inspira Medical Center — Elmer Main Line Health — Paoli Hospital Pennsylvania Hospital Temple — Northeast Campus Warren Delaware Temple University Hospital St. Luke’s Health Network — Warren Hospital Main Line Health — Riddle Hospital Thomas Jefferson University Hospital Delaware Lancaster New Jersey Ephrata Community Hospital New Castle Lancaster General Hospital Burlington Christiana Care Health System — Virtua Marlton Hospital Christiana Hospital Lehigh Virtua Memorial Hospital Christiana Care Health System — Lehigh Valley Hospital Wilmington Hospital Lehigh Valley Hospital — Muhlenberg Camden St. Francis Hospital Sacred Heart Hospital Kennedy University Hospitals — Cherry Hill Division Maryland Kennedy University Hospitals — Cecil Stratford Division Union Hospital Blue Distinction® Center+ Specialties Tier placements are reviewed annually and are subject to Cardiac care Knee and hip replacement change. Visit ibx.com/providerfinder to view a doctor or Spine surgery Maternity care hospital’s tier placement. Be sure to select Keystone HMO Proactive under Your Plan for the tiers to display. .

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